What to do with Infant Poo?
Evidence-based Programming to support safe
disposal of young children’s feces
October 2014
www.wsp.org | www.worldbank.org/water | www.blogs.worldbank.org/water |
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Agenda
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Child Feces Profile Introduction
Participant Introduction
Expert World Café
Working Group Presentation
Gallery Walk
Closing
Profiles outlining the current child feces disposal
practices of caregivers and programs to improve
those practices.
Afghanistan
Burkina Faso
Cambodia
Chad
Ethiopia
India
Indonesia
Kenya
Lao PDR
Madagascar
Malawi
Mozambique
Nepal
Niger
Nigeria
Pakistan
Philippines
Senegal
Sierra Leone
South Sudan
Sudan
Tanzania
Uganda
Vietnam
Zambia
www.wsp.org/childfecesdisposal
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Why Child Feces?
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Higher prevalence of
pathogens in children’s feces
Children’s feces can
contaminate households
leading the way to ingestion of
fecal matter,
Ingestion of fecal matter can
cause poor gut health and
chronic immune stimulation,
leading to malnutrition
Child feces management is not
addressed in many WASH
programs, yet health impacts
are often measured as diarrhea
or stunting on children.
Rural households consistently reported
higher rates of unsafe disposal
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Households with younger children consistently
reported higher rates of unsafe disposal
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The poorest households consistently reported
higher rates of unsafe disposal
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Over 50% of households with children under 3 in 14 of the 24 countries
reported that the feces of their youngest child under age three were not
deposited into any kind of toilet or latrine—i.e. they were unsafely disposed.
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In 12 of the 24 countries, the feces of more than 10
percent of children were reported to be left in the open.
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Young children had worse access than the general
population to improved facilities in 22 of the 24
countries.
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Even among households with improved toilets or
latrines, all countries reported some unsafe child feces
disposal behavior.
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Ideas for Consideration Disclaimer
Given the relatively few programs focusing on
children’s sanitation globally, there is not a strong
evidence base of effective strategies for increasing
the safe disposal of child feces.
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Conduct additional formative research to
understand the behavioral drivers and barriers
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Strengthening efforts to change the behavior of
caregivers
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Partnering with the private sector to improve
feces management tools
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Improve the Enabling Environment for
management of children’s feces
Including related
criteria in:
• open defecation
free verification
protocols,
• sanitation policies,
• strategies, and
• monitoring
mechanisms.
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Exploring opportunities to integrate child sanitation into
existing interventions that target caregivers of young
children
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P
Participant Introduction
Expert World Cafe
Table Options
Julia Rosenbaum
Lindsay Voigt
Lizette Burgers
Faruqe Hussain
Claire Null
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WASHPlus
WaterShed
UNICEF
icddr’b/WASHBenefits Bangladesh
WASHBenefits Kenya
Working Groups
Working group inputs into program
recommendation document- (45 minutes)
Given the relatively few programs focusing on children’s
sanitation globally…
there is not a strong evidence base on what works best
for effectively increasing the safe disposal of child feces.
Significant knowledge gaps must be filled before practical
evidence-based policy and program guidance will be
available.
Nevertheless, those organizations showcased today and
other experts working in or researching children’s
sanitation globally have made
recommendations incorporating child
feces management into existing
programs.
Slide 22
Scaling Up Rural Sanitation
Theory of Change
Slide 23
WASH Improvement Framework
Access to Hardware &
Services
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Water supply
Sanitation systems
Handwashing stations / tippy taps
Soap, containers, water treatment
and other consumables for HWS,
MHM and anal cleansing
• Fecal sludge management/ pit
emptying
Hygiene Promotion
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Mass media
Theater, radio, all folk media
Community Mobilization/ CLTS
School-Led Total Sanitation
Community participation
Household outreach /promotion
Sustainable WASH Improvement
Reduced Diarrhea, Learning Improvement,
Cost Savings, etc. etc.etc.
Enabling Environment
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Supportive policy, tariffs and regulation
Institutional strengthening
Coordinated planning and budgeting
Financing and cost-recovery
Cross-sectoral coordination
Partnerships
SNV Approach
Slide 25
The Stool of Stools
Slide 26
Review recommended program guidance
Organized by
• Formative Research
• Increase Demand
• Improve Supply
• Create or Strengthen the
Enabling Environment and
Integrate with other
child/caregiver programs
Self select a group (one of the
‘pillars’)
Take 25 minutes
Review/ critique/ add/ edit /
subtract
Using a computer, prepare a
slide/few slides to present to
group
Slide 27
Working Group Presentation
Formative Research (To be edited by
participants)
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Conducting additional formative research to understand the behavioral drivers and barriers to safe child feces
disposal
Ensure that behavior, namely safe stool disposal, is assessed according to the standard DHS/MICS approach,
which asks respondents to describe the disposal of feces of the youngest child in the household, and the
practice at last stool disposal.
Additional questions such as where the child defecated, how the feces was disposed of or/and transported, can
also be assessed (see sample questionnaire). Ideally, these questions should be completed by caregivers, and
in reference to what they do with their child or children.
In an ideal situation, include a household roster at the start of the interview:
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Identify all children in the household under the age of 5 or 36 months
– Identify their caregivers
– Ensure that age of each child is recorded
– Administer a short module that addresses feces disposal.
– Analyze data at the individual level, which is among children under the age of 5 or 36 months.
This has the advantage of increasing the sample size, without needing to go to more households, and ensures
that factors such as the child’s age, whether or not he or she is ambulatory or pre-ambulatory, are also captured.
An example of a roster is presented in figure X. In this example there are three children in the household under
the age of five. Elizabeth is a caregiver for two of the children, while Jane is Peter’s caregiver. In this situation,
Elizabeth would complete two modules that assess the how she disposed of the stool for Stephen and Rose,
while Jane would complete the same module for Peter’s stool disposal.
If that is not possible, ask about the youngest child in the household, and identify the caregiver of that child to
complete the questions regarding infant feces disposal.
Avoid using questions that assess what the respondent ‘usually does’ given this is subject to bias and greater
error.
Improved Demand (to be edited by Participants)
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Strengthening efforts to change the behavior of caregivers through
programs that encourage cleaning children after defecation, potty training
children, and using appropriate methods to transport feces to a toilet/latrine
Tailor messaging to caregivers. For example, place emphasis on disposing
the feces into a toilet/latrine for children not developmentally able to use a
toilet.
Introduce education programs in schools and preschools to encourage
caregivers’ understanding that children’s stools are dangerous, in
communities where people consider children’s feces as relatively
inoffensive.
Incorporate the entire range of relevant motivators— health, time saving,
ease of cleaning and pride, etc—into communication materials for
caregivers.
Maximize the frequency of program-to-caregiver contact.
Encourage caretakers to dispose of the wash water properly if washable
diapers or nappies are used.
Communicate the importance of consistency in the new behaviours
established for preventing child feces coming into contact with humans.
Improved Supply (to be edited)
• Partner with the private sector to improve feces
management tools, such as potties, diapers, and scoopers
• Look for any affordable local tool already in the market
that can be redeployed and remarketed for safe feces
disposal—thus making use of pre-existing supply and local
familiarity of the product.
• Encourage the installation of household toilets and a
convenient water supply to increase the availability and
therefore likelihood of safe child feces disposal.
• Encourage toilet training through the use of training tools,
such as the “safe squat,” with use of an improved
toilet/latrine.
• Work with caregivers to define appropriate interventions
and tools for each age of mobility and development.
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Enabling Environment and Integration
(to be edited)
• Improving the enabling environment for management of
children’s feces, by including specific child feces-related criteria in open
defecation free verification protocols, national sanitation
policies, strategies, or monitoring mechanisms.
• Include criteria that a community cannot be certified as open
defecation free unless everyone’s feces are safely disposed of, in
locations using community-led total sanitation.
• Work with governments to incorporate safe disposal of child feces into
existing interventions.
• Maintain a feedback loop between the management of children’s
feces and its impact to correctly identify and address any issues.
• Explore opportunities to integrate child sanitation into existing
interventions that target caregivers of young children, such as including
key messages in antenatal and newborn care materials provided to
parents or ensuring midwives’ training includes information on safe
child feces disposal
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Thank You
www.wsp.org | www.worldbank.org/water | www.blogs.worldbank.org/water |
@WorldBankWater